Healthcare Provider Details

I. General information

NPI: 1326975830
Provider Name (Legal Business Name): JENNIFER NEWSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11783 TULIP CT
FOUNTAIN VALLEY CA
92708-1231
US

IV. Provider business mailing address

11783 TULIP CT
FOUNTAIN VALLEY CA
92708-1231
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-1356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number754673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: